Management of High-Grade Spondylolisthesis Including Reduction Techniques

There exists significant controversy in the literature regarding the surgical treatment of high-grade spondylolisthesis: in situ fusion versus reduction, the timing of surgery, and the techniques for achieving fixation are highly varied. High-grade spondylolisthesis is a complicated, three-dimensional deformity with complex pathomechanics and secondary anatomic changes that develop over time. While the classification schemes and management modalities of high-grade spondylolisthesis continue to evolve with our understanding of these deformities, there is general agreement that surgical treatment of high-grade, unbalanced spondylolisthesis is the management of choice. While reduction and fixation of these high-grade slips are historically fraught with complications, including nerve injury and loss of fixation, in situ fusion is also not without reportedly severe complications. However, in the authors’ varied, multi-year experience, anatomic reduction with interbody fusion and posterior instrumentation has yielded excellent results with a relatively low complication rate.